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Dawe R, Penashue J, Benuen MP, Qupee A, Pike A, van Soeren M, Sturge Sparkes C, Winsor M, Walsh KH, Hasan H, Pollock N. Patshitinikutau Natukunisha Tshishennuat Uitshuau (a place for Elders to spend their last days in life): a qualitative study about Innu perspectives on end-of-life care. BMC Palliat Care 2024; 23:121. [PMID: 38760796 PMCID: PMC11100191 DOI: 10.1186/s12904-024-01431-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 04/09/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND Indigenous palliative persons and their families often have different values, spiritual traditions, and practices from Western culture and Canadian health systems. Additionally, many healthcare policies and practices have been established without adequate consultation of the Indigenous populations they are meant to serve. This can result in barriers to Innu receiving culturally safe end-of-life care. Innu community leaders from Sheshatshiu, Labrador, have identified a need for further research in this area. The purpose of this study is to: (1) describe the cultural and spiritual practices related to death and dying of the Innu in Sheshatshiu; (2) identify aspects of current end-of-life care delivery that serve and/or fail to meet the cultural and spiritual needs of the Innu in Sheshatshiu; and (3) explore ways to integrate current end-of-life care delivery practices with Innu cultural and spiritual practices to achieve culturally safer care delivery for the Innu. METHODS This qualitative patient-oriented research study was co-led by Innu investigators and an Innu advisory committee to conduct semi-structured interviews of 5 healthcare providers and 6 decision-makers serving the community of Sheshatshiu and a focus group of 5 Innu Elders in Sheshatshiu. Data was analyzed thematically from verbatim transcripts. The codebook, preliminary themes, and final themes were all reviewed by Innu community members, and any further input from them was then incorporated. Quotations in this article are attributed to Innu Elders by name at the Elders' request. RESULTS The findings are described using eight themes, which describe the following: relationships and visitation support a "peaceful death"; traditional locations of death and dying; the important role of friends and community in providing care; flexibility and communication regarding cultural practices; adequate and appropriate supports and services; culturally-informed policies and leadership; and Innu care providers and patient navigators. CONCLUSIONS The Innu in Sheshatshiu have a rich culture that contributes to the health, care, and overall well-being of Innu people approaching end of life. Western medicine is often beneficial in the care that it provides; however, it becomes culturally unsafe when it fails to take Innu cultural and spiritual knowledge and traditions into account.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Nathaniel Pollock
- School of Arctic and Subarctic Studies, Labrador Campus, Memorial University, Happy Valley-Goose Bay, Canada
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Hordyk SR, Macdonald ME, Brassard P, Okalik L, Papigatuk L. No time to grieve: Inuit loss experiences and grief practices in Nunavik, Quebec. Transcult Psychiatry 2023; 60:917-928. [PMID: 36344244 PMCID: PMC10725114 DOI: 10.1177/13634615221135423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This article presents an overview of past and current grief rituals and practices and existing grassroots and institutional initiatives seeking to address the complex, prolonged, and traumatic grief experienced by many Inuit living in Quebec. While conducting a study seeking to identify the strengths, resources, and challenges for Nunavik's Inuit communities related to end-of-life care, results emerged concerning how family caregivers' grief related to the dying process was compounded by the sequelae of historic loss experiences (e.g., losses related to Canada's federal policies, including residential schools, forced relocations, and dog slaughters) and by present loss experiences (e.g., tragic and sudden deaths in local communities). To better support caregivers, an understanding of these grief experiences and a vision of bereavement care inclusive of community mobilization efforts to develop bereavement training and support is needed. We conclude with a discussion of a community capacity approach to bereavement care.
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Affiliation(s)
- Shawn Renee Hordyk
- École de travail social, Université du Québec à Montréal Faculté des sciences humaines, Canada
| | | | - Paul Brassard
- Division of Clinical Epidemiology – McGill University Health Centre, McGill University, Canada
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Singh H, Haghayegh AT, Shah R, Cheung L, Wijekoon S, Reel K, Sangrar R. A qualitative exploration of allied health providers' perspectives on cultural humility in palliative and end-of-life care. BMC Palliat Care 2023; 22:92. [PMID: 37434238 DOI: 10.1186/s12904-023-01214-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 06/26/2023] [Indexed: 07/13/2023] Open
Abstract
BACKGROUND Cultural factors, including religious or cultural beliefs, shape patients' death and dying experiences, including palliative and end-of-life (EOL) care preferences. Allied health providers must understand their patients' cultural preferences to support them in palliative and EOL care effectively. Cultural humility is a practice which requires allied health providers to evaluate their own values, biases, and assumptions and be open to learning from others, which may enhance cross-cultural interactions by allowing providers to understand patients' perceptions of and preferences for their health, illness, and dying. However, there is limited knowledge of how allied health providers apply cultural humility in palliative and EOL care within a Canadian context. Thus, this study describes Canadian allied health providers' perspectives of cultural humility practice in palliative and EOL care settings, including how they understand the concept and practice of cultural humility, and navigate relationships with patients who are palliative or at EOL and from diverse cultural backgrounds. METHODS In this qualitative interpretive description study, remote interviews were conducted with allied health providers who currently or recently practiced in a Canadian palliative or EOL care setting. Interviews were audio-recorded, transcribed, and analyzed using interpretive descriptive analysis techniques. RESULTS Eleven allied health providers from the following disciplines participated: speech-language pathology, occupational therapy, physiotherapy, and dietetics. Three themes were identified: (1) Interpreting and understanding of cultural humility in palliative and EOL care (i.e., recognizing positionality, biases and preconceived notions and learning from patients); (2) Values, conflicts, and ethical uncertainties when practicing cultural humility at EOL between provider and patient and family, and within the team and constraints/biases within the system preventing culturally humble practices; (3) The 'how to' of cultural humility in palliative and EOL care (i.e., ethical decision-making in palliative and EOL care, complexities within the care team, and conflicts and challenges due to contextual/system-level factors). CONCLUSIONS Allied health providers used various strategies to manage relationships with patients and practice cultural humility, including intra- and inter-personal strategies, and contextual/health systems enablers. Conflicts and challenges they encountered related to cultural humility practices may be addressed through relational or health system strategies, including professional development and decision-making support.
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Affiliation(s)
- Hardeep Singh
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, 500 University Avenue, Toronto, ON, M5G 1V7, Canada.
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Canada.
| | - Arta Taghavi Haghayegh
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, 500 University Avenue, Toronto, ON, M5G 1V7, Canada
| | - Riya Shah
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, 500 University Avenue, Toronto, ON, M5G 1V7, Canada
| | - Lovisa Cheung
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Sachindri Wijekoon
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, 500 University Avenue, Toronto, ON, M5G 1V7, Canada
| | - Kevin Reel
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, 500 University Avenue, Toronto, ON, M5G 1V7, Canada
- Ethics Centre, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Ruheena Sangrar
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, 500 University Avenue, Toronto, ON, M5G 1V7, Canada
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Bailey NGN, Knott R, Grenier G, Craig KD, Kramer JLK. Physical pain among Indigenous Peoples in Canada: a scoping review. Can J Anaesth 2023; 70:1047-1063. [PMID: 37341897 DOI: 10.1007/s12630-023-02461-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 01/16/2023] [Accepted: 01/29/2023] [Indexed: 06/22/2023] Open
Abstract
PURPOSE Pain is a multifaceted experience shaped by various factors including context of pain, previous life events, and ongoing ethnocultural circumstances. Moreover, the definition of pain is inconsistent across cultures. Western medicine views physical pain (e.g., associated with a bone fracture) and nonphysical mental pain (e.g., depression) as two distinct conditions. Indigenous perspectives are often more wholistic, encompassing mental, spiritual, emotional, and physical hurt. The subjective nature of pain invites ample opportunity for discrimination in both its assessment and management. As such, it is important to consider Indigenous perspectives of pain in research and clinical practice. To investigate which aspects of Indigenous pain knowledge are currently considered by Western research, we conducted a scoping review of the literature on pain in Indigenous Peoples of Canada. SOURCE In June 2021, we searched nine databases and downloaded 8,220 papers after removal of duplicates. Two independent reviewers screened abstracts and full-text articles. PRINCIPLE FINDINGS Seventy-seven papers were included in the analysis. Using grounded theory, five themes emerged: pain measures/scales (n = 7), interventions (n = 13), pharmaceuticals (n = 17), pain expression/experiences (n = 45), and pain conditions (n = 70). CONCLUSION This scoping review shows that there is a paucity of research on pain measurement in Indigenous Peoples of Canada. This finding is concerning in light of numerous studies reporting that Indigenous Peoples experience their pain as ignored, minimized, or disbelieved. Furthermore, a clear disconnect emerged between pain expression in Indigenous Peoples and assessment in medical professionals. We hope that this scoping review will serve to translate current knowledge to other non-Indigenous academics and to initiate meaningful collaboration with Indigenous partners. Future research led by Indigenous academics and community partners is critically needed to better address pain needs in Canada.
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Affiliation(s)
- Nicole G N Bailey
- International Collaboration on Repair Discoveries (ICORD), The University of British Columbia, Vancouver, BC, Canada.
- Department of Medicine, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada.
| | - Robbie Knott
- Indigenous Research Support Initiative, The University of British Columbia, Vancouver, BC, Canada
| | - Georgia Grenier
- International Collaboration on Repair Discoveries (ICORD), The University of British Columbia, Vancouver, BC, Canada
| | - Kenneth D Craig
- Department of Psychology, Faculty of Arts, The University of British Columbia, Vancouver, BC, Canada
| | - John L K Kramer
- International Collaboration on Repair Discoveries (ICORD), The University of British Columbia, Vancouver, BC, Canada
- Department of Anesthesiology, Pharmacology & Therapeutics, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
- Djavad Mowafaghian Centre for Brain Health, The University of British Columbia, Vancouver, BC, Canada
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Panozzo S, Bryan T, Mason T, Garvey G, Lethborg C, Boughey M, Philip JA. Bridging cultures in palliative care: A qualitative study of the care of Indigenous Australians with advanced illness. Palliat Med 2023; 37:498-507. [PMID: 36645146 DOI: 10.1177/02692163221137929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Lack of access, late engagement and limited referral for palliative care remain critical issues in supporting Indigenous Australians with life limiting illness. AIM To explore the experiences and perspectives of Indigenous and non-Indigenous health professionals regarding the provision of palliative care for Indigenous people with advanced disease. DESIGN Qualitative study involving semi-structured focus groups/interviews with analysis following an inductive thematic approach. SETTING/PARTICIPANTS A purposive sample (n = 54) of medical, nursing, allied health and Indigenous Hospital Liaison Officers engaged in caring for Indigenous patients at a metropolitan teaching hospital in Australia. RESULTS Four overarching themes were identified regarding provision of palliative care for Indigenous patients. These were (1) the intersection of cultures - Indigenous peoples, health and palliative care, (2) bridging the cultural divide: the integral role of Indigenous Hospital Liaison Officers, (3) health professionals devolve their responsibility to provide culturally appropriate care and (4) building towards a more holistic, culturally aware provision of palliative care. CONCLUSIONS For many Indigenous people, the health system may be experienced as inflexible, narrowly focused and even prejudiced and traumatising. For Indigenous patients at the end of life, these challenges are heightened. The Indigenous Hospital Liaison Officers, working at the intersections of these two cultures, are key to negotiating such challenges as they seek opportunities to facilitate communication and understanding between firmly held cultural needs.
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Affiliation(s)
- Stacey Panozzo
- Palliative Nexus, St Vincent's Hospital Melbourne, Melbourne, Australia.,Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Tamsin Bryan
- Palliative Care Services, St Vincent's Hospital Melbourne, Melbourne, Australia
| | - Toni Mason
- Aboriginal Health Unit, St Vincent's Hospital Melbourne, Melbourne, Australia
| | - Gail Garvey
- Inclusive Health, St Vincent's Health Australia, Brisbane, Australia.,School of Public Health, Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Carrie Lethborg
- Department of Social Work, St Vincent's Hospital Melbourne, Melbourne, Australia.,Centre for Rural Health, University of Tasmania, Tasmania, Australia
| | - Mark Boughey
- Palliative Care Services, St Vincent's Hospital Melbourne, Melbourne, Australia
| | - Jennifer A Philip
- Palliative Nexus, St Vincent's Hospital Melbourne, Melbourne, Australia.,Department of Medicine, University of Melbourne, Melbourne, Australia
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Ristevski E, Leach M, Bolton E, Spargo M, Byrne A, Khalil H. Rural community-based nurses' self-reported knowledge and skills in the provision of psychosocial care to palliative and end-of-life clients and carers. Palliat Support Care 2022; 20:823-831. [PMID: 36942580 DOI: 10.1017/s1478951521001644] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE This study examined rural community-based nurses' self-reported knowledge and skills in the provision of psychosocial care to rural residing palliative and end-of-life clients and carers. We further sought to determine correlates of knowledge gaps to inform workforce education and planning. METHOD Nurses from a rural area of Victoria, Australia, were invited to complete an electronic questionnaire rating their knowledge against 6 national palliative care standards and 10 screening and assessment tools. A 5-point scale of (1) No experience to (5) Can teach others was used to rate knowledge. Results were classified into three categories: practice gaps, areas of consolidation, and strengths. Descriptive and logistical regression was used to analyze data. RESULTS A total of 122 of 165 nurses (response rate = 74%) completed the survey. Of these nurses, 87% were Registered Nurses, 43% had ≥10 years' experience in palliative care, and 40% had palliative care training. The majority of practices across the standards and screening and assessment tools were rated as knowledge strengths (N = 55/67, 82%). Gaps and areas of consolidation were in the use of client and carer assessment tools, the care of specific populations such as children, supporting carers with appropriate referrals, resources, and grief, and facilitating the processes of reporting a death to the coroner. Lack of formal training and lower years of experience were found to be associated with practice gaps. SIGNIFICANCE OF RESULTS Our study found rural nurses were confident in their knowledge and skills in the majority of psychosocial care. As generalist nurses make up the majority of the rural nursing workforce, further research should be undertaken on what educational strategies are needed to support and upskill rural community-based nurses to undertake formal training in palliative care.
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Affiliation(s)
- Eli Ristevski
- Monash Rural Health Warragul, Monash University, Victoria, Australia
| | - Michael Leach
- Monash Rural Health Bendigo, Monash University, Victoria, Australia
| | - Ellen Bolton
- Monash Rural Health Warragul, Monash University, Victoria, Australia
| | - Melissa Spargo
- Gippsland Region Palliative Care Consortium, Victoria, Australia
| | - Anny Byrne
- Gippsland Region Palliative Care Consortium, Victoria, Australia
| | - Hanan Khalil
- College of Science, Health & Engineering, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
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Zhang X, Zhang X, Li Y, Chen T, Siow L, Ye X, Wang Y, Wang Y, Ming WK, Sun X, Xiang Z, Wu Y, Wu J. What are the acceptances and associated influences of hospice care in Mainland China? A national cross-sectional study. Front Public Health 2022; 10:985218. [PMID: 36211671 PMCID: PMC9544594 DOI: 10.3389/fpubh.2022.985218] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 08/29/2022] [Indexed: 01/25/2023] Open
Abstract
Background China ranks 53rd out of 81 countries in the Quality of Death Index for 2021. Although hospice care demand is increasing, the progress remains slow. It is of great significance to explore the acceptances and associated influencing factors of hospice care. Methods A cross-sectional survey by quota sampling was conducted in China from July 10th to September 15th, 2021. We collected demographic data and hospice care acceptance. A stepwise linear regression analysis was used. Results This survey contained 11,031 valid questionnaire results to investigate the hospice care acceptance. It was found that individuals with undergraduate or above (β = 0.04), more properties [2 (β = 0.02), 3 (β = 0.01)], and higher reimbursement types of medical insurance [employee health insurance and commercial health (β = 0.03), government insurance (β = 0.04)] had higher hospice acceptance willingness, while males (β = -0.02) were less willing to accept than females. Psychological conditions [mild anxiety (β = 0.03), moderate anxiety (β = 0.01), moderate stress (β = 0.05), and severe stress (β = 0.06)] also played an important role. The Self-Management Scale (SHMS) (β = 0.12), EuroQol Five Dimensions Questionnaire (EQ-5D) (β = 0.05), EuroQol Visual Analog Scale (EQ-VAS) (β = 0.21), Short-Form Family Health Scale (FHS-SF) (β = 0.12), higher scores of the Short-Form Health Literacy Instrument (HLS-SF12) (β = 0.16), and Perceived Social Support Scale (PSSS) (β = 0.10) also contributed. Gender subgroup showed that in the male group, age, highest educational level, marital status, number of properties, whether having children, psychological conditions, the SHMS, EQ-5D, EQ-VAS, HLS-SF12, and PSSS showed significant difference. Urban and rural subgroups showed that age, highest educational level, number of properties, whether having chronic disease or psychological conditions, the SHMS, EQ-VAS, HLS-SF12, and PSSS were contributing factors in rural areas. Conclusion The average score of acceptance of hospice care was 65.02 points. Gender, house, anxiety, pressure, social support, and health literacy were the main influencing factors on residents' attitudes.
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Affiliation(s)
- Xinyue Zhang
- Key Laboratory of Oral Biomedical Research of Zhejiang Province, Stomatology Hospital, School of Stomatology, Zhejiang University of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Cancer Center of Zhejiang University, Hangzhou, China
| | - Xun Zhang
- Department of Surgical Oncology, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China,Zhejiang University School of Medicine, Hangzhou, China
| | - Yiqi Li
- Zhejiang University School of Medicine, Hangzhou, China,Chu Kochen Honors College of Zhejiang University, Zhejiang University, Hangzhou, China
| | - Tianle Chen
- Chu Kochen Honors College of Zhejiang University, Zhejiang University, Hangzhou, China
| | - Lixuen Siow
- Key Laboratory of Oral Biomedical Research of Zhejiang Province, Stomatology Hospital, School of Stomatology, Zhejiang University of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Cancer Center of Zhejiang University, Hangzhou, China
| | - Xinxin Ye
- School of Public Health, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, China
| | - Yinlin Wang
- Key Laboratory of Oral Biomedical Research of Zhejiang Province, Stomatology Hospital, School of Stomatology, Zhejiang University of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Cancer Center of Zhejiang University, Hangzhou, China
| | - Yujia Wang
- College of Humanities and Social Sciences, Harbin Medical University, Harbin, China
| | - Wai-Kit Ming
- Department of Infectious Diseases and Public Health, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Kowloon, Hong Kong SAR, China
| | - Xinying Sun
- Department of Social Medicine and Health Education, School of Public Health, Peking University, Beijing, China
| | - Ze Xiang
- Zhejiang University School of Medicine, Hangzhou, China,Ze Xiang
| | - Yibo Wu
- Department of Social Medicine and Health Education, School of Public Health, Peking University, Beijing, China,Yibo Wu
| | - Jian Wu
- Department of Laboratory Medicine, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou, China,*Correspondence: Jian Wu
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Colclough Y, Brown GM. Attitudes and Beliefs of End-of-Life Care Among Blackfeet Indians. Am J Hosp Palliat Care 2022:10499091221119141. [PMID: 35951460 DOI: 10.1177/10499091221119141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Disparity in hospice use threatens optimal quality of life during the final stage of life while American Indians/Alaska Natives may not be aware of hospice benefits. Our established Blackfeet members and Montana State University collaborative team conducted a modified Duke End-of-Life Care Survey (8 sections with 60 questions) to assess a baseline end-of-life values, beliefs, and attitudes of Blackfeet individuals. In this manuscript, we present the results of 3 sections with 28 questions: Preference of Care; Beliefs About Dying, Truth Telling, and Advance Care Planning; and Hospice Care by examining overall and generational differences. Most participants (n = 92) chose quality of life over quantity of life with using various devices if they had an incurable disease (54-82%), would want to know if they were dying (92%) or had cancer (89%), but had not thought or talked about their preference of end-of-life care (30% and 35% respectively). The results portray understandable cultural context as well as generational differences with personal variability. While an affirmative shift towards hospice was emerging, dissemination of accurate hospice information would benefit people in the partner community. In conclusion, an individual-centered approach-understanding individual need first-may be the most appropriate and effective strategy to promote hospice information and its use.
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Affiliation(s)
- Yoshiko Colclough
- Mark & Robyn Jones College of Nursing, 33052Montana State University, Bozeman, MT, USA
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Racine L, Fowler-Kerry S, Aiyer H. Integrative review of the needs and challenges of indigenous palliative care in rural and remote settings. J Adv Nurs 2022; 78:2693-2712. [PMID: 35578573 DOI: 10.1111/jan.15287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 03/09/2022] [Accepted: 04/26/2022] [Indexed: 11/30/2022]
Abstract
AIMS To appraise and synthesize the empirical literature on the needs and challenges of Indigenous peoples' accessibility to palliative care in rural and remote settings. DESIGN Whittemore and Knafl's updated approach to integrative reviews, PRISMA guidelines and CASP (2020) checklists for narrative analysis were followed. DATA SOURCES A systematic search of the published empirical literature from 1 January 2015 to 31 December 2021 was undertaken in five databases. REVIEW METHODS Twenty-four studies met the research question and the inclusion criteria. RESULTS Four themes describe the findings: Respect of Indigenous cultural beliefs on death and dying, connection to the land, needs for culturally responsive care and presence of institutional and systemic barriers. These themes indicate a pressing need to increase the accessibility and utilization of palliative care. Most of the studies were qualitative and conducted by teams of Indigenous and non-Indigenous researchers. CONCLUSION Integrating Indigenous knowledge and providing culturally responsive palliative care are steps towards achieving the decolonization of palliative care and responding to Indigenous people's needs of palliative care services. Institutional and systemic racism affect Indigenous peoples' access and delivery of palliative services in Canada and globally. IMPACT The review highlights the need for establishing partnerships and building local capacity with Indigenous communities to develop and implement culturally responsive palliative care programmes in remote locations.
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Affiliation(s)
- Louise Racine
- College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Susan Fowler-Kerry
- College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Harini Aiyer
- Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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Kroik L, Tishelman C, Stoor K, Edin-Liljegren A. A Salutogenic Perspective on End-of-Life Care among the Indigenous Sámi of Northern Fennoscandia. Healthcare (Basel) 2021; 9:766. [PMID: 34205402 PMCID: PMC8234930 DOI: 10.3390/healthcare9060766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 06/09/2021] [Accepted: 06/15/2021] [Indexed: 11/27/2022] Open
Abstract
There is limited empirical data about both health and end-of-life (EoL) issues among the Indigenous Sámi of Fennoscandia. We therefore aimed to investigate experiences of EoL care and support among the Sámi, both from the Sámi community itself as well as from more formalized health and social care services in Sweden. Our primary data source is from focus group discussions (FGDs) held at a Sámi event in 2017 with 24 people, complemented with analysis of previously collected data from 15 individual interviews with both Sámi and non-Sámi informants familiar with dying, death and bereavement among Sámi; "go-along" discussions with 12 Sámi, and individual interviews with 31 Sámi about advance care planning. After initial framework analysis, we applied a salutogenic model for interpretation, focusing on a sense of community coherence. We found a range of generalized resistance resources in relation to the Sámi community, which appeared to support EoL care situations, i.e., Social Organization; Familiarity with EoL Care, Collective Cultural Heritage; Expressions of Spirituality; Support from Majority Care Systems; and Brokerage. These positive features appear to support key components of a sense of community coherence, i.e., comprehensibility, meaningfulness and manageability. We also found relatively few, but notable deficits that may diminish the sense of community coherence, i.e., lack of communication in one's own language; orientation, familiarity and/or agreement in contacts with formal health and social care systems; and/or support from extended family. The results suggest that there is a robust basis among Sámi for well-functioning EoL care; a challenge is in developing supportive interactions with the majority health and social care systems that support and complement these structures, for partnership in developing care that is meaningful, comprehensible and manageable even in potentially difficult EoL situations.
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Affiliation(s)
- Lena Kroik
- Department of Nursing, Umeå University, 901 87 Umeå, Sweden;
- The Center for Rural Medicine, Region Västerbotten, 923 31 Storuman, Sweden
| | - Carol Tishelman
- LIME/Division of Innovative Care Research, Karolinska Institutet, 171 77 Stockholm, Sweden;
- Stockholm Health Care Services, 171 77 Stockholm, Sweden
| | - Krister Stoor
- Department of Language Studies, Umeå University, 901 87 Umeå, Sweden;
- Centre for Sámi Studies-Várdduo, Umeå University, 907 87 Umeå, Sweden
| | - Anette Edin-Liljegren
- Department of Nursing, Umeå University, 901 87 Umeå, Sweden;
- The Center for Rural Medicine, Region Västerbotten, 923 31 Storuman, Sweden
- LIME/Division of Innovative Care Research, Karolinska Institutet, 171 77 Stockholm, Sweden;
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Pak A, Adegboye OA, Eisen DP, McBryde ES. Hospitalisations related to lower respiratory tract infections in Northern Queensland. Aust N Z J Public Health 2021; 45:430-436. [PMID: 33900652 DOI: 10.1111/1753-6405.13104] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 12/01/2020] [Accepted: 02/01/2021] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To investigate the admission characteristics and hospital outcomes for patients admitted with lower respiratory tract infections (LRTI) in Northern Queensland. METHODS We perform a retrospective analysis of the data covering an 11-year period, 2006-2016. Length of hospital stay (LOS) is modelled by negative binomial regression and heterogeneous effects are checked using interaction terms. RESULTS A total of 11,726 patients were admitted due to LRTI; 2,430 (20.9%) were of Indigenous descent. We found higher hospitalisations due to LRTI for Indigenous than non-Indigenous patients, with a disproportionate increase in hospitalisations occurring during winter. The LOS for Indigenous patients was higher by 2.5 days [95%CI: -0.15; 5.05] than for non-Indigenous patients. The average marginal effect of 17.5 [95%CI: 15.3; 29.7] implies that the LOS for a patient, who was admitted to ICU, was higher by 17.5 days. CONCLUSIONS We highlighted the increased burden of LRTIs experienced by Indigenous populations, with this information potentially being useful for enhancing community-level policy making. Implications for public health: Future guidelines can use these results to make recommendations for preventative measures in Indigenous communities. Improvements in engagement and partnership with Indigenous communities and consumers can help increase healthcare uptake and reduce the burden of respiratory diseases.
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Affiliation(s)
- Anton Pak
- Australian Institute of Tropical Health and Medicine, James Cook University, Queensland
| | - Oyelola A Adegboye
- Australian Institute of Tropical Health and Medicine, James Cook University, Queensland.,Public Health and Tropical Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, Queensland
| | - Damon P Eisen
- Australian Institute of Tropical Health and Medicine, James Cook University, Queensland.,College of Medicine and Dentistry, James Cook University, Queensland
| | - Emma S McBryde
- Australian Institute of Tropical Health and Medicine, James Cook University, Queensland
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Peplow D, Augustine S. The Submissive Relationship of Public Health to Government, Politics, and Economics: How Global Health Diplomacy and Engaged Followership Compromise Humanitarian Relief. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E1420. [PMID: 32098351 PMCID: PMC7068329 DOI: 10.3390/ijerph17041420] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 02/17/2020] [Accepted: 02/20/2020] [Indexed: 11/30/2022]
Abstract
This paper describes efforts by public health practitioners to address a health crisis caused by economic development policies that are unrestrained by either environmental, public health, or human rights mandates. Economic development projects funded by international funding institutions like the Inter-American Development Bank that reduce poverty when measured in terms of Gross Domestic Product (GDP) per capita in the transborder region between Suriname and French Guiana harm minority populations where commercial activities destroy, alter, and remove the resources upon which local communities depend. In this study, the structural causes of a community health crisis affecting Indigenous people in the transborder region between Suriname and French Guiana was addressed by seeking gatekeepers in government who have access to policy-making processes. We found that deeply rooted economic development policies structured social, economic, and political alliances and made them resistant to feedback and reform. We concluded that work must be focused beyond the simple exchange of public health information. Public health practitioners must become politically active to create new policy commitments and new patterns of governance that advance development as well as improve health outcomes. Failure to do so may result in public health practitioners becoming 'engaged followers' that are complicit in the inhumanity that springs from their acquiescence to the authority of government officials when their policies are the cause of preventable death, disease, and disability.
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Affiliation(s)
- Daniel Peplow
- Department of Health Services, University of Washington, White Swan, WA 98952, USA
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13
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Prince H, Nadin S, Crow M, Maki L, Monture L, Smith J, Kelley ML. "If you understand you cope better with it": the role of education in building palliative care capacity in four First Nations communities in Canada. BMC Public Health 2019; 19:768. [PMID: 31208402 PMCID: PMC6580639 DOI: 10.1186/s12889-019-6983-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 05/15/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In Canada, there is a growing need to develop community-based, culturally appropriate palliative care for Indigenous people living in First Nations communities. The public health approach to palliative care, which emphasizes community-based initiatives, is especially relevant in First Nations communities because care is grounded in their distinct social and cultural context. Central to the public health approach are educational strategies that strengthen communities' capacity to care for their vulnerable members as they die. This paper presents community-based research conducted with First Nations communities in Canada that aimed to assess and address local palliative care educational needs to improve community capacity in palliative care. METHODS Participatory action research (PAR) was conducted with four First Nations communities in Canada over a six-year period (2010-2016). The research occurred in three phases. Phase 1: focus groups, interviews and surveys were employed to assess community specific needs and resources. Phase 2: recommendations were developed to guide the PAR process. Phase 3: educational resources were created to address the identified educational needs. These resources were implemented incrementally over 4 years. Ongoing process evaluation was employed, and revisions were made as required. RESULTS Educational needs were identified for patients, families, community members and internal and external health care providers. A wide and comprehensive range of educational resources were created to address those needs. Those culturally appropriate educational resources are available in a very accessible and useable workbook format and are available for use by other Indigenous people and communities. CONCLUSIONS This research provides an example of the public health approach and offers implementation strategies around palliative care education. This paper contributes to the international literature on the public health approach to palliative care by presenting a case study from Canada that includes: conducting a culturally appropriate assessment of educational needs, creating recommendations, facilitating development and implementation of educational resources in the community to improve community capacity in palliative care.
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Affiliation(s)
- Holly Prince
- Centre for Education and Research on Aging & Health, Lakehead University, 955 Oliver Rd, Thunder Bay, Ontario, P7B 5E1, Canada
| | - Shevaun Nadin
- Centre for Education and Research on Aging & Health, Lakehead University, 955 Oliver Rd, Thunder Bay, Ontario, P7B 5E1, Canada. .,Centre for Rural and Northern Health Research, Lakehead University, 955 Oliver Rd, Thunder Bay, Ontario, P7B 5E1, Canada. .,Department of Health Sciences, Lakehead University, 955 Oliver Rd, Thunder Bay, Ontario, P7B 5E1, Canada.
| | - Maxine Crow
- Netaawgonebiik Health Services, Naotkamegwanning First Nation, ON, Canada
| | - Luanne Maki
- Fort William First Nations Health Centre, Fort William First Nation, ON, Canada
| | - Lori Monture
- Six Nations Long Term Care/Home and Community Care Program, Six Nations of the Grand River Territory, ON, Canada
| | - Jeroline Smith
- Peguis Home and Community Care, Peguis First Nation, MB, Canada
| | - Mary Lou Kelley
- Centre for Education and Research on Aging & Health, Lakehead University, 955 Oliver Rd, Thunder Bay, Ontario, P7B 5E1, Canada.,School of Social Work, Lakehead University, 955 Oliver Rd, Thunder Bay, Ontario, P7B 5E1, Canada
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14
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Schill K, Caxaj S. Cultural safety strategies for rural Indigenous palliative care: a scoping review. BMC Palliat Care 2019; 18:21. [PMID: 30764810 PMCID: PMC6376644 DOI: 10.1186/s12904-019-0404-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 02/04/2019] [Indexed: 11/18/2022] Open
Abstract
Background There is little scholarship on culturally safe approaches to palliative care, especially for rural Indigenous clients. Thus, it is important to articulate how cultural safety can be enacted to support rural Indigenous Peoples and communities at end of life. We sought to identify strategies described in existing literature that have potential to deepen our understanding of culturally safe approaches to palliative care within rural and small-town settings in Canada. Methods We searched for peer-reviewed and grey literature about Indigenous palliative care in rural and small-town settings in Canada, United States, New Zealand, and Australia. Medline, CINAHL, and Embase were searched. We thematically analyzed 22 resulting articles to address our interest in culturally safe approaches to palliative care in rural/small-town and on-reserve contexts. Results The following themes were extracted from the literature: symbolic or small gestures; anticipating barriers to care; defer to client, family and community; shared decision-Making; active patient and family involvement; respectful, clear, and culturally appropriate communication; community ownership of services; empower cultural identity, knowledge, and traditions; and, policy. Discussion Culturally competent practices can improve Indigenous palliative care services; however, they do not result in decolonized care. Strategies include: symbolic or small gestures; anticipating barriers to access; deferring to the client, family, and community members; and, collective decision making and family involvement. Culturally safe approaches contribute to institutional or organizational change and decolonized care. Strategies include: involvement of patient and family in service planning; reflection about individual and systemic racism; community ownership of services and; recognizing distinct Worldviews that shape care. Conclusions Culturally safe strategies invite decolonization of care through awareness of colonialism, racism, and discrimination. They invite commitment to building partnerships, power sharing, and decision-making in the delivery of care. Culturally competent activities may catalyze the adoption of a cultural safety framework; however, mislabeling of cultural competency as cultural safety may contribute to organizational inaction and a watering down of the spirit of cultural safety.
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Affiliation(s)
- Kaela Schill
- Cumming School of Medicine, Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
| | - Susana Caxaj
- School of Nursing, Faculty of Health and Social Development, Okanagan Campus, University of British Columbia, Kelowna, British Columbia, Canada
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15
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Colclough YY, Brown GM. Moving Toward Openness: Blackfeet Indians' Perception Changes Regarding Talking About End of Life. Am J Hosp Palliat Care 2018; 36:282-289. [PMID: 30556405 DOI: 10.1177/1049909118818255] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This study was conducted to examine cultural appropriateness and readiness for the Blackfeet people in the United States talking about end of life. In the past, a taboo perception of Blackfeet traditional belief in end-of-life discussion was identified as a core barrier for hospice use. However, a recent anecdotal increase in hospice interest triggered the research team to investigate community-wide interest as well as traditional appropriateness of hospice introduction. The community-based participatory research approach was used to conduct the study. Using convenience sampling, we interviewed 10 tribally recognized Elders and surveyed 102 tribal members who were over 18 years old using a modified Duke End-of-Life Care Survey. Here, our report focused on the perception changes on end-of-life discussion. The elders' statements were divided into two, saying that an end-of-life discussion was not against tradition and that sickness and death would break the living spirit, thus no such discussion. Despite, the importance of a family gathering and the need for knowledge about end-of-life care were confirmed. The survey (response rate 100%; n = 92) showed that 90% of the respondents thought dying was a normal part of life and 76% felt comfortable talking about death. In conclusion, there was a shift in the Blackfeet Indians' attitude toward end-of-life discussion from reluctance to at ease. Recommendations specific to the Blackfeet-related entities are presented.
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Affiliation(s)
| | - Gary M Brown
- 2 Eagle Shield Center, Blackfeet Nation, Browning, MT, USA
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Sullivan R, Ugalde A, Sinclair C, Breen LJ. Developing a Research Agenda for Adult Palliative Care: A Modified Delphi Study. J Palliat Med 2018; 22:480-488. [PMID: 30461347 DOI: 10.1089/jpm.2018.0462] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Background: Little is known about research priorities in adult palliative care. Identifying research priorities for adult palliative care will help in increasing research quality and translation. Objective: The aim was to identify the views of health professionals' research priorities in adult palliative care that lead to development of a palliative care research agenda in Australia. Design: A modified three-round Delphi survey. Setting/Subjects: Palliative care researchers and clinicians in Australia were invited to participate. Results: A total of 25 panelists completed round 1, 14 completed round 2, and 13 completed round 3. Round 1 resulted in 90 research priorities in 13 categories. Round 2 showed consensus agreement on 19/90 research priorities. Round 3 resulted in the top 10 research priorities of the 19 achieving consensus in round 2. Panelists agreed that research is needed on the transition to palliative care; improving communication about prognosis; increasing access to palliative care for indigenous communities, people who wish to remain at home, and people in aged care; addressing family caregivers' needs; promoting patients' and families' decision making; improving cross-cultural aspects of palliative care; determining the effects of assisted dying legislation; and improving bereavement care in rural, remote, and Aboriginal populations. Conclusions: The expert panelists identified the top 10 research priorities for adult palliative care. These identified research priorities are the most urgent topics requiring attention to increase the quality of life of patients requiring palliative care and their family members.
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Affiliation(s)
| | - Anna Ugalde
- 2 School of Nursing and Midwifery, Deakin University, Geelong, Australia
| | - Craig Sinclair
- 3 Rural Clinical School of Western Australia, University of Western Australia (Albany Centre), Albany, Australia
| | - Lauren J Breen
- 1 School of Psychology, Curtin University, Perth, Australia
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